硝酸甘油预防经内镜逆行胰胆管造影术后胰腺炎及高淀粉酶血症的临床对照研究

Nitroglycerin for prevention of post-ERCP pancreatitis and hyperamylasemia

目的探讨预防性使用硝酸甘油对经内镜逆行胰胆管造影（ERCP）术后胰腺炎及高淀粉酶血症的作用及安全性。方法按既定标准入选接受ERCP诊治患者150例，随机表法随机分为硝酸甘油组和对照组，分别给予硝酸甘油（0．5mg舌下含服）和安慰剂（维生素C0．1g舌下含服），观察术后胰腺炎和高淀粉酶血症发生情况，观察不良反应。结果剔除3例不符合研究要求者，147例患者ERCP术后急性胰腺炎发生率为16．3％（24例），高淀粉酶血症发生率为28．6％（42例）。其中胰腺炎的发生率，硝酸甘油组低于对照组（12．2％比20．5％），但差异无统计学意义（Х^2=1．892，P=0．169）；高淀粉酶血症发生率，硝酸甘油组为20．3％（15／74），低于对照组的37．0％（27／73），差异有显著性意义（Х^2=5．032，P=0．025）。两组均未出现严重不良反应。结论硝酸甘油能有效预防ERCP术后高淀粉酶血症的发生，而对术后胰腺炎的预防作用尚不肯定。硝酸甘油药物安全性好。

Objective To study the preventive effects of Nitroglycerin （NTG） on post-ERCP pancreatitis （PEP） and hyperamylasemia. Methods A total of 150 patients were enrolled and randomly divid- ed into 2 groups to receive buccal NTG 0.5mg （NTG group） or buccal Vitamin C 0. 1 g （control group）. Incidence of PEP and hyperamytasemia and adverse reactions were observed. Results Three patients were excluded according to the exclusion criteria. The overall incidences of PEP and hyperamylasemia were 16. 3% （24/147） and 28. 6% （42/147）, respectively. The incidence of hyperamylasemia in NTG group （15/74, 20. 3% ） was significantly lower than that of control group （27/73, 37. 0% ） （X^2 =5. 032, P = 0. 025）. Incidence of PEP in NTG group （12. 2% ） was lower than that of control group （20. 5% ） without significance （X^2 = 1. 892, P = 0. 169）. No severe adverse effects was observed. Conclusion NTG can effectively prevent post-ERCP hyperamylaemia, but its effect on PEP is limited.